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COLORADO SEARCH AND RESCUE FUND

VIEWS: 19 PAGES: 3

  • pg 1
									COLORADO SEARCH AND RESCUE FUND MISSION REPORT – PRIORITY TIERS I, II AND III
A. B. 1. Applicant County 4. County Case # 2. Sheriff 5. Date and Time Mission Started 3. Telephone

Colorado Department of Local Affairs #______________ ___

GENERAL INFORMATION __________________________________________________________________

Is this mission reported submitted for reimbursement from the Search and Rescue Fund? Yes No If so, please complete license information, fill in all relevant cost information and attach necessary receipts, etc. 6. Funding Tier – Check appropriate box (attach license if available) Tier I – Subject Licensed Tier II – Relative Licensed Conservation Cert. No. Vehicle Registration No. CORSAR Card No. B.

Tier III – No License Date of Purchase Date of Purchase Date of Purchase

SUBJECT INFORMATION ______________________________________________________________________ 1. Subject Name A. B. C. D. Address Date of Birth Sex

2. Licensed Relative’s Name/Relationship if applicable C.

_______________________________________________

FINANCIAL INFORMATION ____________________________________________________________________ Itemized Costs (attach original invoice) 1. Equipment Hourly/Unit Cost Subtotal

2. Mileage

3. Meals 4. Room Rental 5. Other TOTAL AMOUNT REQUESTED

D.

SEARCH INFORMATION 1.Unit Submitting Report 2.Incident Commander

__________________________________________________________________ Unit Missions # AFRCC # F. ____________________ _________________________

E.

DESCRIPTION OF INCIDENT

DESCRIPTION OF RESPONSE

[Attach sheet if additional narrative is required] ACTIVITY Climber Hiker Fisherman Hunter Bicycle Boat OHV Snowmobile Aircraft Walkaway Evid. Search Skier Other SITUATION Lost/Overdue Stranded Injury Illness Public Service Other Response Type Standby Responded Search Rescue Recovery Other Land Air Water (if lost) Search Techniques Used Confinement Attraction Hasty Search Visual Tracking Search Dogs Line Search Air Search Other Rescue/Recovery Techniques Used Assist/Own Power Carry-Out by Foot Rock/Scree Evac. Evac. By Animal Watercraft Evac. Vehicle Evac. Aircraft Evac. Other

G.

RESULTS _______________________________________________________________________________ Subject(s) Found/Rescued: Date _______________ Time __________________ By SAR Effort By Public (non/SAR) By Self Never Needed Help Clues Found By Interrogation Confinement Attraction Hasty Search Visual Tracking Search Dogs Line Search Helicopter Fixed Wing Subject’s Signal Other Subject Found By Not Found/Rescued Other ____________________ As result of SAR effortTotal number of persons FOUND RESCUED SAVED DESCRIPTION OF FIND/RESCUE

Reason Terminated Successful Lack Manpower Lack Equipment Lack Support Lack Clues Hazardous Terrain Severe Weather Area too Large Authority Decision Family Decision Other ________ H. MEDICAL

(if lost) Found In Primary Search Area Secondary Search Area Area Previously Searched Out of Area Home, Bar, Motel, etc. Other__________

________________I. SUBJECT BEHAVIOR Cause of Incident Unknown Human Error (self) Another Person Darkness Environment/wx Falling Object Equipment Failure Other

____________________________ _________ (if injury) Reason(s) Unknown Haste Exceeded Ability Fatigue Fall or Slip Inadequate Equipment Anchor/Belay Failed Other

Extent of Injuries A B C Uninjured st Slight/1 Aid Moderate/Dr. Severe/Hospital Fatal

(if lost) Reason(s) Unknown Poor Supervision Accidental Supervision Intentional Separation Took Short Cut Poor/No Map Disoriented Misjudged Time/Distance

TRAVEL DATA (if lost) Air distance from last Seen point (miles) Time Moving (hours):

________________________________________________________________________ Elevation change from last seen Point to where found (feet) UP DOWN

SAME ELEVATION

DAY

NIGHT

BOTH

K. RESOUCES EQUIPMENT INVOLVED AND COSTS No. Miles/Hours Helicopter Fixed Wing Ambulances 2 WD Vehicles 4 WD Vehicles Power Boats Snowmobiles Horses Dogs MANHOURS SUMMARY Total number of your personnel involved Total manhours expended by your unit Total number of ALL personnel involved Total manhours expended by ALL personnel

Costs

L.

OTHER SAR UNITS INVOLVED Unit Name

1) 2) 3) 4) 5) 6)

M.

AUTHORIZATION I certify that the above report and listing of expenses is true and correct. I have attached all applidable original receipts and understand that I am responsible for disbursement of monites to all agencies or groups that assisted in this search and rescue incident. MISSION REPORT/REQUEST PREPARED BY: NAME REQUEST APPROVED BY:
SHERIFF’S ORIGINAL SIGNATURE REQUIRED FOR REIMBURSEMENT

RANK

DATE

N.

DLA/SAR FUND RECEIPT/APPROVAL REQUEST REVIEW BY: REQUEST APPROVED BY: DATE: DATE:


								
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